1 Evaluating the Safety and Efficacy of Classical Greek and Roman Treatments Compared to Modern Treatment Morgan Wynes PharmD/MBA Candidate Class of The University of Rhode Island, College of Pharmacy Introduction Results24 Gout 3,4 90% of patients have under-excretion of uric acid. Symptoms are painful, red, swollen lower extremities. Flare Treatment: NSAIDs, COX-2 Inhibitors, Systemic corticosteroids, colchicine Prevention: Xanthine oxidase inhibitors Pennyroyal5,6 Cucumber7 Poppy8,9 Autumn Crocus10,11 Classical Greek and Roman society made many medical advances. Hippocrates was the most important contributor to Greek medicine. During his life he shifted Greek medicine away from spiritual medicine toward practical medicine.1 Galen was the most important contributor to Roman medicine and was considered to be the father of medicine for the next 1400 years. Galen theorized that the circulatory system was used to carry more than just blood and his work led to the discovery of capillaries.2 Active ingredient is pulegone Pulegone has not been studied in gout. Pulegone is hepatotoxic in concentrations of greater than 10 mL. Active ingredients are apigenin and quercetin. Both have anti-inflammatory properties similar to NSAIDs. No reports of human toxicity Absorbs morphine inside the seed pod Morphine alleviates the pain of a gout flare. Morphine does not treat the cause of gout. Active ingredient is colchicine Colchicine is toxic in doses > 1.2 mg per day. Deaths have occurred from accidental ingestion. Purpose Assess the treatments of disease used in classical Greece and Rome and compare them to the treatment methods currently used Gain knowledge of disease states not covered in pharmacy curriculum Develop understanding of Classical Greek and Roman culture beyond what is covered in traditional Classics courses Improve drug information skills Beet Juice15 Basil5,17 Jaundice12,13 Skin and mucous membranes are visibly yellow Caused by hyper-bilirubinemia which results from many factors such as alcoholic hepatitis. Treatment of alcoholic hepatitis: Systemic corticosteroids Chicory14 Garlic5,16 Methodology Decreased AST and ALT in mice with hepatic steatosis though not to normal. Can cause GI upset and increased risk of bleeding. Decreased AST and ALT in goats. Not tested in humans. Potentially safe if taken in medicinal doses. Tested in mice given CCl4 Inhibited toxic effects of CCl4 and minimized rise in AST and ALT. Active ingredient is betaine No significant change in AST and ALT  in steatosis grade Ancient texts were analyzed for diseases with tell tale symptoms and associated treatments. The main resource consulted was Natural History by Pliny. Tertiary resources were consulted to provide background on diseases. Primary sources were consulted using mainly PubMed and Embase. Those primary sources were used to assess the efficacy of the classical treatment in the disease state as well as to assess the safety and potential toxicities of those treatments. Finally tertiary resources were consulted to assess the safety, efficacy and mechanism of action of the modern treatments for the same disease. References Elephantiasis18,19 Enlargement of lower limbs Caused by a blockage of the lymphatic system. Caused by S. pyogenes or S. aureus Treatment: Penicillin G then Penicillin VK Asparagus20 Mint5,21 Marketos Spyros G. History of Medicine. Athens University Medical School Web site. Published May Accessed March 9, 2016. Galen. Internet Encyclopedia of Philosophy Web site. Accessed March 4, 2016. Khanna D, Fitzgerald J, Khanna P, Bae S, Singh M, Neogi T, et al American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res. 2012; 64: Khanna D, Khanna P, Fitzgerald J, Singh M, Bae S, Neogi T, et al American College of Rheumatology guidelines for management of gout. Part 2: therapy and anti-inflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res. 2012; 64: Jellin JM, Gregory PJ, Batz F, Bonakdar R, et al. Natural Medicines Comprehensive Database. Stockton CA: Therapeutic Research Faculty; Accessed January 2, 2017. Anderson IB, Mullen WH, Meeker JE, Khojasteh-Bakht SC, Oishi S, Nelson SD, et. al. Pennyroyal toxicity: measurement of toxic metabolite levels in two cases and review of the literature. Ann Intern Med. 1996; 124: Cucumbers. The world’s healthiest foods Web site. Published Updated Accessed January 27, 2017. Can Poppy Seeds Cause A Positive Drug Test? U.S. Anti-Doping Agency Web site. Published February 9, Updated December Accessed January 28, 2017. Gold Standard, Inc. Morphine. Clinical Pharmacology [database online]. Available at: Accessed January 28, 2017. Gold Standard, Inc. Colchicine. Clinical Pharmacology [database online]. Available at: Accessed January 30, 2017. 36th International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) May, 2016, Madrid, Spain, Clin Toxicol (Phila). 54:4, Herrine S. Jaundice. Merck Manual Professional Version Web site. Published May Accessed February 24, 2017. O’Shea RS, Dasarathy S, McCullough AJ, Shuhart M, Davis G, Franco J. et al. Alcoholic liver disease. Hepatology. 2009; 51: Elgengaihi S, Mossa AH, Refaie A, Aboubaker D. Hepatoprotective efficacy of cichorium intybus L. extract against carbon tetrachloride-induced liver damage in rats. J Diet Suppl. 2016; 13: Abdelmalek MF, Sanderson SO, Angulo P, Soldevila-Pico C, Chen L, Peter J, et. al. Betaine for nonalcoholic fatty liver disease: Results of a randomized placebo-controlled trial. Hepatology. 2009; 50: Shin JH, Lee CW, Oh SJ, Yun J, Kang MR, Han SB. Hepatoprotective effect of aged black garlic extract in rodents. Toxicol Res. 2014; 1: Meera R, Devi P, Kameswari B, Madhumitha B, Merlin NJ. Antioxidant and hepatoprotective activities of Ocimum basilicum Linn. And Trigonella foenum-graecum Linn. against H2O2 and CCl4 induced hepatotoxicity in goat liver. Indian J Exp Biol. 2009; 47: Gold Standard, Inc. Naloxone. Clinical Pharmacology [database online]. Available at: Accessed January 28, 2017. Elephantiasis. National Organization for Rare Disorders. Web site. https://rarediseases.org/rare-diseases/elephantiasis/. Published Accessed March 9, 2017. Teka A, Rondevaldova J, Asfaw Z, Demissew S, Van Damme P, Kokoska L, et al. In vitro antimicrobial activity of plants used in traditional medicine in Gurage and Silti Zones, south central Ethiopia. BMC Complement Altern Med. 2015; 15: Iscan G, Kirimer N, Kurkcuoglu M, Husnu K, Baser C, Demirci F. Antimicrobial screening of menthe piperita essential oils. J. Agric. Food Chem. 2002; 50: Empyema. MedlinePlus Web site. https://medlineplus.gov/ency/article/ htm. Published February 4, Updated March 9, Accessed March 25, 2017. Wessels MR. Streptococcal Infections. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Harrison’s Principles of Internal Medicine, 19e New York, NY: McGraw-Hill; 2014. 24. Pliny, Jones WHS. Natural History VI. Books XX-XXIII. Cambridge, MA: Harvard University Press; 1969. Did not inhibit S. aureus or S. pyogenes Antibacterial effect against S. aureus Not tested against S. pyogenes Safe for use < 8 weeks Conclusion Some treatments such as colchicine and pleural drainage are still used in practice today though they have been refined to be safer for the patient. Other products such as cucumber, chicory and garlic show promise and could be approved for use with further study. The remaining treatments; pennyroyal, poppy, mint, asparagus, beets and basil, either lack the necessary evidence of effectiveness or their therapeutic benefit does not exceed their toxic potential when taken at medicinal dosages. Pleural Empyema 1,22,23 Buildup of infected pus in the pleural space Symptoms are fever, chills, shortness of breath and cough. Treatment: Clindamycin and Penicillin G Secondary Treatment: Surgical drainage Surgical drainage was practiced by Hippocrates. Improper sanitation made this procedure dangerous. Sponsored by Dr. Kristina Ward1 and Dr. Daniel Carpenter2 1The University of Rhode Island, College of Pharmacy, 2The University of Rhode Island, College of Arts and Sciences, Department of Modern and Classical Languages and Literatures, Classics Section Head